The Tippecanoe County Health Department has been working on a proposal for a syringe exchange program for more than a year.

New governor Eric Holcomb promised in his State of the State address to make it easier for counties to establish syringe exchange programs and a bill moving through the legislature would make that possible.

But the programs still face significant opposition from officials, and funding the programs remains the largest barrier.

“There’s a lot of different parts, and trying to make sure all those parts were met to have the state approval for the syringe exchange program was a daunting task,” says Tippecanoe County Public Health Nursing Supervisor Khala Hochstedler. “And some people were kind of scared of that process here.”

An unprecedented outbreak of HIV cases in Scott County two years ago marked a change in how state officials address the state’s drug epidemic. People were sharing dirty needles to shoot up powerful prescription painkillers.

Then-governor Mike Pence approved a bill that allowed counties to establish programs where intravenous drug users could turn in used needles for clean ones. But counties have to get state approval before they start an exchange.

Gov. Eric Holcomb wants to change that, and he included that goal as one of his top priorities in his first State of the State Address.

“We have heroes on the front lines saving lives every day. They include the public health nurses who run syringe exchange programs in 9 Indiana counties,” Holcomb said “And that’s why we will give county officials authority to establish syringe exchange programs to ensure that the people making the decisions are those closest to the problem.”

House Bill 1438, authored by Republican Cindy Kirchhofer, eliminates the step that requires state approval.

“The reality is that these exchange programs have actually morphed into a distribution program where the exchange is not necessary in order to get the needles,” Hill said. “What ends up happening is you get a net increase in the number of needles, and that net increase in the number of needles can provide a greater risk of exposure and expansion of the infectious diseases that we’re trying to prevent.”

But the Centers for Disease Control and Prevention says that’s not true. In fact, it encourages the expansion of the programs nationwide.

“It seemed like he was not really aware of the research and evidence that’s out there that that is not true,” says Dr. Carrie Lawrence, Director of Project Cultivate at the Rural Center for AIDS and STD prevention. “In fact, it reduces the harms associated with injection drug use.”

But Attorney General Hill isn’t alone in his concerns. Back in Tippecanoe County, Hochstedler says progress is slow because of local opposition. At the public hearing back in November, both the Lafayette Mayor and the Chief of Police spoke against the idea.

“A lot of people don’t understand exactly what a syringe exchange program is,” she says. “They just think it’s giving people needles and then you’re condoning drug use.”

But Hochstedler says the programs offer a lot more than that: overdose intervention drugs, health insurance help, referrals to addiction and mental health counselors, help with transportation, food, immunizations and vaccines. The program will offer STD testing and condoms. And all of that is free for participants.

The Greatest Barrier: Funding

Those costs add up quickly, and state law prohibits any state funding for the programs.

In Tippecanoe County, health officials say securing funds from private donations and grants is the biggest reason they don’t already have a syringe exchange.

“It’s been almost all funding,” says Amanda Balser, Grant Financial Supervisor. “We already had our plan in place, we already knew what we wanted. The state approved our plan immediately, we never had to go back and forth on that, so everything has been funding.”

“I feel like this bill initially has moved in the right direction and I think Gov. Holcomb was very brave in his willingness to even state this needs to be brought down to a local level.”

—Dr. Carrie Lawrence, Project Cultivate

But state funding isn’t being addressed this legislative session.

Before the election, Holcomb expressed tentative support for funding syringe exchanges through the state. But he now defers to a new statewide position he created: the Executive Director for Drug Prevention, Treatment and Enforcement Jim McClelland.

McClelland fully supports the proposal to give county officials authority to establish a needle exchange, but has not announced his position on state funding.

Dr. Lawrence says she wants to see a lot more progress.

“I have a laundry list of kind of like, what I want this to look like,” she says. “But I feel like this bill initially has moved in the right direction and I think Gov. Holcomb was very brave in his willingness to even state this needs to be brought down to a local level.”